Medicaid expansion right for the county

By Deb Cardin | Mar 14, 2013

I have the privilege of serving an organization whose mission and vision uphold the moral conviction that every person deserves access to health care.

At Jefferson County Health Center our commitment to serving as a healing presence to the most vulnerable among us means the debate over whether Iowa should expand the Medicaid health insurance program comes down to a moral question. We believe caring for the least fortunate among us is simply the right thing to do.

We also believe that expanding Medicaid is the right decision to protect jobs and help enhance our state’s business climate. If other states expand their Medicaid populations and Iowa does not, Iowa facilities will supplement those states’ economies. Failing to expand Medicaid means Iowa turning its back on hundreds of millions of dollars of federal healthcare dollars that would support jobs and create more business.

At Jefferson County Health Center we appreciate the complexity of the Medicaid program for both the federal government and our state legislators. We also understand the challenge of forecasting the financial impact of a “yes” or a “no” decision. However, I think it’s important to note that the Affordable Care Act includes various insurance taxes and fees, limitations on medical expense deductions, medical device taxes and Medicare payment reductions of approximately $158 billion to hospitals in order to guarantee the federal government can afford its promise to states that expand Medicaid coverage.

As an organization that takes its healing mission very seriously, we believe that expanding access to health care to an additional population of very low-income Iowans fits squarely within our mission to serve all who need our medical care. We also believe our hospital’s mission reflects the priorities and values of the communities JCHC serves.

Others share that conviction. In deciding that his state should move forward with Medicaid expansion, Ohio Republican Gov. John Kasich said he was guided by his personal ethics. “I can’t look at the disabled, I can’t look at the poor, I can’t look at the mentally ill, I can’t look at the addicted and think we ought to ignore them,” he said. Similarly, Gov. Rick Scott of Florida, also a Republican, said, “America’s greatness is largely because of how we value the weakest among us ... I cannot, in good conscience, deny Floridians the needed access to health care.”

A decision against extending Medicaid coverage to more Iowans also will have a severe financial impact on health care providers, potentially forcing some to eliminate jobs. At JCHC, we already will need to absorb significant cuts in reimbursement resulting from sequestration.

JCHC and other Iowa health care providers already serve those who would benefit from Medicaid expansion when they become so sick they need care in our emergency room – and we absorb those costs as unreimbursed charity care. This, too, reflects the hospital’s mission, but the rate of growth for charity care is unsustainable and undermines our ability to support the overall demand not only for hospital services, but for other community-benefiting programs that, frankly, only our organization can provide.

More importantly, the Emergency Room, the most expensive entry point into the healthcare system, is no replacement for a personal physician. But it is practically impossible for someone to establish a relationship with a primary care provider – to create a “medical home,” if you will – when they are uninsured. This is why we must expand Medicaid coverage, including mental health benefits, to as many low-income Iowans as possible.

JCHC has supported the governor’s goal of making Iowa the healthiest state in the nation. We take an active role in improving the wellness of the people and communities we serve. The hospital works continuously to improve the quality of care for every patient while also creating efficiencies that ensure every healthcare dollar is wisely spent.

Providing high-value health care is part of our mission that also reflects the expectations of the community. Accomplishing this goal – ensuring quality while also lowering health care costs through improved care management – will also fuel economic growth, a top priority for both our state and county.

However, refusing to expand Medicaid and keeping thousands of poor Iowans uninsured undermines the physical and mental health of our people and the economic vitality of our hospitals and our state.

If Iowa legislators decide against Medicaid expansion, we will be left with the worst of both worlds: providing more uncompensated care for Iowans still not eligible for Medicaid while receiving less money from the federal government to cover these costs. And we will have let down thousands of struggling Iowans who are counting on our compassion.